Objective To determine the efficacy of combination of loop diuretics with thiazides in the treatment of gross edema in the elderly with chronic kidney diseases (CKD). Methods Full clinical data of senile CKD patients with grossly peripheral edema admitted in our department between May 2012 and April 2014 were collected in this study. Based on administration of thiazides or not, they were assigned to the furosemide/ hydrochlorothiazide (F/H) group and the F/spironolactone (F/S) group. The patients of the former group received furosemide 20mg tid and hydrochlorothiazide 25mg bid orally, and those of the latter group received furosemide 20mg tid and spironolactone 20mg bid. The efficacies of the 2 different combination treatments were compared after 7d of treatment. Results The decreases of body mass, 24h urine volume, natrium (Na) and brain natriuretic peptide (BNP) levels were more significant in F/H group than in F/S group after treatment (P＜0.05). After treatment, the body mass, systolic blood pressure and Na level were reduced (P＜0.05), while, the 24h urine volume and serum albumin were increased in the both groups (P＜0.05). The edema level was alleviated obviously in the patients of F/H group than in those of F/S group (P＝0.000), and severe edema disappeared in the F/H group (P＜0.05). Conclusion Combination of loop diuretics with thiazides exerts good effect in the elderly patients with severe nephrotic edema, and even is safe and effective for those with renal insufficiency.